Intended for healthcare professionals

Criticism of health professionals

The BMJ sometimes publishes articles that criticise health professionals. Being a professional implies operating to a higher ethical standard than the general population. Thus, when balancing the interest of patients and the profession against those of an individual professional, The BMJ has an obligation to give more weight to the interests of patients and the profession than might be the case if a publication was balancing the interest of a lay individual against those of the general community.

The BMJ has guidelines on articles in which the health professionals are clearly identified and those in which they are not, and some elements are common to both:

• Those accused of wrongdoing have the right to a proper investigation using due process;
• "Trial by media"—including The BMJ—cannot constitute due process;
• The media have a job to expose wrongdoing and the failure to deal adequately with wrongdoing;
• Professional journals have an interest to raise wrongdoing; not just to expose individuals but also to illustrate professional problems;
• Doctors and other health professionals are not entitled to any more protection from accusations of wrongdoing than anyone else;
• Because of the sensitivity of articles that make accusations against individuals The editor should be involved in all decisions on whether to publish and s/he should consult with at least two other editorial colleagues. Sometimes it will be necessary to consult more widely.

Articles in which the doctors or other health professionals are clearly identified

The article must clearly avoid libel. The facts being "true" will not be enough on its own. It will be necessary to be able to convince a court that they were "true". In other words, we will need to satisfy ourselves that we have the evidence. If in any doubt over libel (and there is usually doubt), then take legal advice.

Major accusations of unprofessional conduct should be investigated by employers, the General Medical Council, or other institutions that can ensure due process. We will want to report the results of such investigations if they have a broad importance. We may want to include comments from those who have made the accusation, the accused, those who held the investigation, or other commentators—on, for instance, the broader significance of the investigation. It is not essential after an inquiry to get comments from everybody or necessarily from the accused. But "balance" should be considered. For example, if you have a quote from those who made the accusations you should consider getting a quote from the accused—and if you decide not to you should be prepared to justify your decision.

We will not make substantial criticisms of named doctors and other health professionals in the journal except in the following circumstances:

• An investigation has been held and the results are publicly available;
• There is evidence that the investigation was inadequate;
• There seems no possibility of an investigation being held;
• When an investigation has been held we must aim for balance. This will almost always mean getting a quote from the "accused".

Articles in which the doctors or health professionals are not identified

The BMJ often wants to publish articles, including scientific papers, which expose poor performance by doctors and other health professionals. If the aim is to expose wrongdoing by particular individuals, then individuals should be named and the guidelines above followed. If, however, the aim is to make a general point about professional performance then the following guidelines should apply:

We must be clear that the aim is not to expose the wrongdoing of an individual but to make a general point. The general point should clearly be important. The importance of the general point must be weighed against the possible damage to an individual or individuals.

We must ensure that the individuals cannot be identified. This will usually mean that the article will have to be anonymous. If, however, a considerable number of individuals (say, more than 15) are being criticised at once—for instance general practitioners in a particular city—then the article may not have to be anonymous.

We must recognise, however, that anonymity is hard to achieve. With information that emerges from the doctor-patient relationship we have set a standard that even the patients themselves should not be able to recognise that the information is about them. This means, in effect, that informed consent must be obtained from patients in all cases. It is not necessary to achieve this degree of anonymity with papers that describe the wrongdoing of individual professionals and are published because of their general importance. In other words, it will not be necessary to get consent for publication from the accused individuals even if the individuals, their immediate colleagues, and those making the accusation and some of their advisors, family, and friends may recognise the individuals from anonymous articles. If a wider circle than this can recognise the individuals then the guidelines for when individuals can be recognised should be followed.

If all the previous guidelines are followed then it will not be necessary to include quotes from the accused.